Response: Effectiveness of Intratympanic Dexamethasone Injection in Sudden-Deafness Patients as Salvage Treatment

Objective: To study the effectiveness of intratym-panic dexamethasone (IT-DEX) in patients with severe or profound sudden sensorineural hearing loss (SSNHL) after treatment failure with conventional therapy. Study Design: Randomized, controlled study. Methods: Patients who met the criteria for SSNHL, with a severity of severe to profound, underwent 10 days of standard treatment with oral steroid and other facilitating agents. Patients showing poor response to standard treatment were assigned randomly to a control group or to a group receiving IT-DEX. IT-DEX injections were performed once a week for 3 consecutive weeks. Pure-tone audiometry was obtained before each injection. Minimum follow-up time was 1 month. Successful treatment was defined as a hearing improvement of greater than 30 dB. Results: Thirty-nine patients meeting the inclusion criteria were studied. After treatment with oral steroid, 10 of 39 (26%) patients demonstrated hearing improvement, whereas the remaining 29 (74%) patients showed a hearing improvement of less than 30 dB. For those without hearing improvement, 15 received IT-DEX, and 14 received further standard treatment (except oral steroid and carbogen inhalation). Hearing improved in 8 of 15 (53.3%) compared with 1 of 14 (7.1%), with an average decrease in threshold of 28.4 dB and 13.2 dB for the IT-DEX group and the control group, respectively (P < .05). Prognostic factors such as age, treatment delay time, and sex did not significantly affect the response to therapy. Conclusions: IT-DEX injection effectively improves hearing in patients with severe or profound SSNHL after treatment failure with standard therapy and is not associated with major side effects. It is therefore a reasonable alternative as salvage treatment.

Background: Tinnitus is a common distressing complain characterized by perceived sensation of sound without an external stimulus. Intra-tympanic (IT) dexamethasone injection is used for the treatment of tinnitus associated with sensory neural hearing loss (SNHL) by introducing dexamethasone through the tympanic membrane, leading to decreasing sys-temic toxicity and a higher perilymph steroid level.Aim of the Study: The aim of this study was to express our experience in evaluation the effect of IT dexamethasone injection for controlling idiopathic chronic tinnitus of cochlear origin associated with SNHL.Patients and Methods: A prospective interventional study of eighty patients with subjective idiopathic tinnitus associated with SNHL for at least 1 year were treated by IT injection of dexamethasone, once per week for 4 weeks. Improvement in tinnitus was assessed using pure-tone audiometry, speech audiometry, tinnitus matching test, and Tinnitus Handicap Inventory by comparing the results before and after therapy. Follow-up after the end of the four injections, 1 and 3 months later.Results: Pure-tone audiometry did not show significant improvement. However, there was a significant improvement in speech audiometry, tinnitus loudness, and Tinnitus Handicap Inventory after the end of the four injections and in the subsequent evaluations 1 and 3 months later.Conclusion: IT dexamethasone injection could be a simple and effective method for controlling subjective idiopathic chronic tinnitus. The tinnitus may not disappear, but could be markedly decreased and easily tolerated.

We investigated whether the round window membrane (RWM) vibration can facilitate dexamethasone perfusion via the RWM in patients with sudden hearing loss. Prospective study. We first performed an in vitro study using a semipermeable membrane. In the subsequent in vivo study, 20 mice were randomized into two groups: an intratympanic dexamethasone injection (ITDI)-only group, and an ITDI with RWM vibration group. Concentration of dexamethasone was investigated using high performance liquid chromatography. Third, we performed a prospective clinical study. Fifty-five refractory sudden hearing loss patients were divided into two groups: those who received ITDI only (n = 36) and those who received ITDI with RWM vibration (n = 19). Final hearing assessments were conducted 2 months after salvage treatment. In the in vitro study, the concentration of dexamethasone increased with vibration time with the peak concentration observed at 3 minutes of vibration. In the in vivo study, ITDI with RWM vibration resulted in a significantly higher perilymph concentration of dexamethasone (7.68 ± 3.13 µg/ml) than that in the ITDI-only group (2.66 ± 1.73 µg/ml). In a clinical setting, the overall improvement in hearing was similar between the two groups. However, when we compared the speech discrimination score between the two groups, we found that the relative discrimination gain in the ITDI with RWM vibration group (18.11 ± 23.54%) was higher than that in the ITDI-only group (7.00 ± 15.54%) (P = 0.042). RWM vibration can enhance the effect of intratympanic dexamethasone injection and is a viable treatment option for sudden hearing loss. N/A.

The purpose of this study was to investigate the effectiveness of intratympanic dexamethasone injection (ITDI) in acute tinnitus of presumed cochlear origin. A prospective, randomized, placebo-controlled, double-blinded, multicenter study. Between August 2013 and December 2015, 54 patients with unilateral tinnitus were enrolled at four different centers. Patients were assigned either to an ITDI (n = 27) or an intratympanic normal saline injection (ITNI; n = 27) group through block randomization. Intratympanic injections were administered four times over 2 weeks. At 4 weeks after initial injection, we analyzed the improvement rates of tinnitus using the tinnitus handicap Inventory (THI) and visual analogue scale (VAS) for loudness, awareness, and annoyance. We defined improvement as the reduction of more than 7 points or of more than 20% in the final THI score compared to the initial THI score. The initial mean hearing thresholds and VAS and THI scores of the two groups did not differ significantly. At 4 weeks after initial injection, the mean VAS and THI scores of both groups had significantly reduced. However, the improvement rate did not differ significantly between the groups (ITDI, 51.9%; ITNI, 59.3%). The results indicate that ITDI might not be more effective than ITNI for the treatment of acute unilateral tinnitus. Therefore, ITDI should not be considered as the main treatment for patients presenting with acute tinnitus as the primary symptom. 1b. Laryngoscope, 128:184-188, 2018.

Tinnitus is a common and distressing symptom that is characterized by the perceived sensation of sound without a corresponding external stimulus. Intratympanic (IT) dexamethasone injection is used for the treatment of tinnitus by introducing the substance through the tympanic membrane, resulting in reduced systemic toxicity and a higher perilymph steroid level. The aim of this study was to evaluate the effect of IT dexamethasone injection for controlling idiopathic tinnitus of cochlear origin. A total of 30 patients with subjective idiopathic tinnitus for at least 6 months were subjected to IT injection of dexamethasone, once per week for 4 weeks. Improvement in tinnitus was assessed using pure-tone audiometry, speech audiometry, tinnitus matching test, and Tinnitus Handicap Inventory by comparing the results before and after therapy. Pure-tone audiometry did not show significant improvement. However, there was a significant improvement in speech audiometry, tinnitus loudness, and Tinnitus Handicap Inventory after the end of the four injections and in the subsequent evaluations 1 and 3 months later. IT dexamethasone injection could be a simple and effective method for controlling subjective idiopathic tinnitus. The tinnitus may not disappear, but will be alleviated, enabling the patient to cope more easily with the disease, and thus reducing their handicap.

To study the effectiveness of intratympanic dexamethasone (IT-DEX) in patients with severe or profound sudden sensorineural hearing loss (SSNHL) after treatment failure with conventional therapy. Randomized, controlled study. Patients who met the criteria for SSNHL, with a severity of severe to profound, underwent 10 days of standard treatment with oral steroid and other facilitating agents. Patients showing poor response to standard treatment were assigned randomly to a control group or to a group receiving IT-DEX. IT-DEX injections were performed once a week for 3 consecutive weeks. Pure-tone audiometry was obtained before each injection. Minimum follow-up time was 1 month. Successful treatment was defined as a hearing improvement of greater than 30 dB. Thirty-nine patients meeting the inclusion criteria were studied. After treatment with oral steroid, 10 of 39 (26%) patients demonstrated hearing improvement, whereas the remaining 29 (74%) patients showed a hearing improvement of less than 30 dB. For those without hearing improvement, 15 received IT-DEX, and 14 received further standard treatment (except oral steroid and carbogen inhalation). Hearing improved in 8 of 15 (53.3%) compared with 1 of 14 (7.1%), with an average decrease in threshold of 28.4 dB and 13.2 dB for the IT-DEX group and the control group, respectively (P <.05). Prognostic factors such as age, treatment delay time, and sex did not significantly affect the response to therapy. IT-DEX injection effectively improves hearing in patients with severe or profound SSNHL after treatment failure with standard therapy and is not associated with major side effects. It is therefore a reasonable alternative as salvage treatment.

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The aim of this study is to assess the effect of intratympanic dexamethasone injection (ITDI) in patients with idiopathic sudden sensorineural hearing loss (ISSNHL).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A prospective study was conducted on 40 patients refractory to intravenous steroid therapy between May 2012 to March 2014. Intratympanic dexamethasone injection was given every week for 3 consecutive weeks. Hearing was assessed by performing pure tone audiogram before every ITDI and also 1 week after the completion of treatment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Hearing improvement was seen in 27 out of the 40 cases (68%).&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Intratympanic dexamethasone significantly improves the prognosis of ISSNHL and is a safe, inexpensive and effective treatment in ISSNHL.&lt;/p&gt;

BACKGROUNDAs sudden sensorineural hearing loss (SSNHL) rarely occurs in pregnant women, there is a lack of knowledge and relevant research on its management.AIMTo investigate the effect of intratympanic dexamethasone injection in the treatment of pregnant patients with SSNHL.METHODSA retrospective chart review was made for the period between June 2017 and August 2019 at our Department of Otorhinolaryngology-Head and Neck Surgery. Pregnant women who met the criteria for SSNHL were included and grouped based on the therapeutic modalities. The treatment group received intratympanic dexamethasone (2.5 mg) q.o.d. for a total of four times, while the control group received no medication other than bed rest and medical observations. All the patients were under close care of obstetricians. Pure-tone audiograms were performed before and after treatment.RESULTSEleven patients who met the inclusion criteria were assigned to the treatment group (n = 7) and the control group (n = 4). The mean age of patients was 31.2 ± 3.8 years; the right ear was affected in seven (63.64%) cases. Two patients (18.2%) suffered from vertigo, 10 (90.9%) suffered from tinnitus and 6 (54.5%) suffered from aural fullness. The time from onset to clinic visit was relatively short, with a mean time of 1.3 ± 0.9 d. All the women were within the second or third trimester; the average gestation period was 26.0 ± 6.2 wk. The pure-tone averages at onset between the two groups were similar. After one wk of therapy, the treatment group had a curative rate of 57.1% and a significantly better hearing threshold and greater improvement compared to the control group (all P < 0.05). Some patients experienced transient discomfort from intratympanic injections that disappeared after getting rest, while none had permanent complications. All patients delivered healthy full-term neonates with an average Apgar score of 9.7 ± 0.5.CONCLUSIONIntratympanic dexamethasone injections can be used as a first-line therapy in pregnant women with SSNHL.

The protective effect of intratympanic dexamethasone on cisplatin-induced ototoxicity in guinea pigs

The purpose of this study was to investigate the effectiveness of intratympanic dexamethasone injection as a therapeutic agent against cisplatin-induced ototoxicity. Animals were randomly divided into three groups. Group one received intraperitoneal cisplatin alone, group two, received intratympanic dexamethasone after cisplatin ototoxicity had been demonstrated. Group three, which is control group, received intratympanic dexamethasone.Then we made three measurements. First we measured the baseline distortion product otoacustic emission (DPOAEs) of all the guine pigs. Second we injected cisplatin intraperitoneal group one and two the same day. Third we measured DPOAEs after 72h of group one and two. Moreover DPOAEs were measured at the end of the first and second week only in group two. Cochleae were harvested and processed for electron microscopy after then. Values of The DPOAEs amplitudes and signal-to-noise ratio (SNR) at 1-6kHz frequencies for group 1 after the injections significantly decreased over those before injections (P<0.05). In group 3, there were no significant differences in DPOAE amplitude and SNR values When they are compare before and after their intratympanic dexamethasone injections (P>0.05). In group 2, the DPOAEs measurements were close to significance at the end of the second week (P=0.056). Intratympanic dexamethasone injection did not cause any ototoxic effect. Although intratympanic dexamethasone did not reach the statistically significant results, the measurements were close to significance. Intratympanic dexamethasone might have a significant therapeutic effect after cisplatin ototoxicity with different dose and application regimens.

Introduction&#x0D; Oral steroids currently represent the standard treatment for idiopathic sudden sensorineural hearing loss The aim of this study is to assess the effectiveness of intratympanic dexamethasone injection for treating ‘Idiopathic sudden sensori-neural hearing loss’ (ISSNHL) not improved with conventional oral steroid.&#x0D; Materials and Methods&#x0D; A prospective study was conducted on 30 patients refractory to oral steroid therapy between June 2017 to May 2018. ‘Intratympanic dexamethasone injection’ (ITDI) was given every week for 3 consecutive weeks. Hearing was assessed by performing pure tone audiogram before every ITDI and also 1 week after the completion of treatment.&#x0D; Results&#x0D; Hearing improvement was found in 19 out of the 30 cases (63.3%).&#x0D; &#x0D; Conclusions&#x0D; Intratympanic dexamethasone significantly improves the prognosis of ISSNHL and is a safe, inexpensive and effective treatment.

This case-control study aimed to analyze the effect of intratympanic dexamethasone injection (ITDI) as a treatment option for patients with sudden sensorineural hearing loss (SSNHL) who were refractory to classic oral steroid treatment. Sixty-six patients with SSNHL, who were refractory to a course of oral steroid therapy, were included in this study. We prospectively treated consecutive 33 patients (34 ears) with ITDI from August 2002 to January 2004. We then retrospectively collected data from age- and sex-matched previous patients who did not take any more treatments after the initial regimen between March 2000 and July 2002. ITDI was performed in the supine position on four separate occasions over the course of 2 weeks. Hearing was assessed immediately before every injection and at 1 week after therapy. Hearing improvement was defined as more than 10 dB in pure-tone average (PTA). Hearing improvement was observed in 13 (39.4%) of 33 patients who underwent ITDI and in two (6.1%) of 33 patients in the control group. Five of 13 represented hearing improvement over than 20 dB in PTA, and 11 of 20 patients, who showed no improvement in PTA by ITDI, showed improvement over 10 dB in some frequencies. There were no definite prognostic factors between the patients who responded to ITDI and those who did not. ITDI may be a simple and effective therapy for patients with refractory SSNHL.

ObjectivesIntratympanic dexamethasone injection (ITDI) has been introduced as a treatment option for subjective tinnitus. However, the effects of ITDI on patients with tinnitus remain unclear. In the present systematic review and meta-analysis, we evaluated the effectiveness of ITDI for tinnitus treatment.MethodsWe searched Medline, the Cochrane Central Register of Controlled Trials, and Embase. Four double-blind randomized controlled trials that tested the efficacy of ITDI compared with a placebo were deemed eligible for a quantitative meta-analysis, while four prospective studies and seven retrospective studies reporting the effectiveness of ITDI on tinnitus treatment were included in a qualitative synthesis.ResultsIn the four studies included in the quantitative meta-analysis, ITDI did not show evidence of tinnitus improvement compared with placebo (odds ratio [OR], 1.38; 95% confidence interval, 0.53–3.61). In the 11 studies included in the qualitative synthesis, seven retrospective studies without controls reported rates of tinnitus improvement after ITDI ranging from 35.9% to 91.3%. In the four prospective studies with controls, ITDI seemed to be effective when combined with other drugs for tinnitus treatment.ConclusionITDI alone did not show a significant effect for treating tinnitus compared with placebo. However, the potential of combination treatment of ITDI with other drugs for tinnitus therapy should be further studied in more systematic research.

BackgroundThe aim of this study was to determine whether different concentrations of intratympanic (IT) injection of dexamethasone at a dose of 4 and 10 mg/mL have an effect on hearing outcomes in patients with idiopathic sudden sensorineural hearing loss (ISSNHL).ResultsOur study was conducted on 30 adult patients with unilateral ISSNHL who failed to respond or with contraindications to systemic steroids. Patients were categorized into two groups; each one included 15 patients. IT injection of 4 mg/mL dexamethasone was done in one group (IT dexamethasone (Dex) 4 mg/mL), while 10 mg/mL dexamethasone was administered intratympanically in the other group (IT Dex 10 mg/mL). IT injection was performed twice weekly for two successive weeks. PTA thresholds were assessed at 0.5, 1, 2 and 4 kHz before and 1 month after the treatment.In the group with IT Dex 10 mg/mL, the average PTA improved significantly from 75.50 ± 12.59 to 49 ± 24.04 dB with an average gain of 26.50 ± 14.25 (p = 0.0007). In the group with IT Dex 4 mg/mL, there was a significant change of PTA from a pretreatment value of 76.92 ± 11.89 dB to a post-treatment value of 59.27 ± 92.10 dB with an average gain of 17.65 ± 8.36 dB.A comparison of the post-treatment gain of PTA in both groups showed better improvement of hearing in a group treated by IT Dex 10 mg/mL compared with 4 mg/mL.ConclusionThis study demonstrated that IT injection of dexamethasone at a dose of 10 mg/ml was associated with better hearing outcomes compared with 4 mg/mL for the treatment of ISSNHL.

Background: Intratympanic injection has emerged as a novel approach to bypass the blood-labyrinth barrier and effectively deliver drugs into the inner ear. This technique is used for treatment of various inner ear diseases and overcomes the limitations of systemic drug therapy. In this paper, we provide an overview of the application of intratympanic injection using steroids and gentamicin and highlight the major diseases and summarize the reported efficacy of this approach.Current Concepts: Intratympanic steroid injections have been used for treatment of various inner ear diseases, including sudden sensorineural hearing loss, Ménière disease, and tinnitus. Therapeutic effects of steroids include reducing inflammation, modulating the immune response, improving cochlear blood flow, and maintaining ion homeostasis. Intratympanic gentamicin injections are primarily used to minimize hearing loss and control vertigo symptoms in patients with Ménière disease. Gentamicin selectively injures vestibular hair cells with minimal ototoxicity compared with other aminoglycoside antibiotics.Discussion and Conclusion: Intratympanic injections offer several advantages, including targeted drug delivery, minimal systemic adverse effects, and rapid action. Reportedly, intratympanic steroid injections used as primary or salvage treatment are associated with positive outcomes in patients with sudden sensorineural hearing loss. Ménière disease also shows positive outcomes following intratympanic steroid and gentamicin injections. However, studies have reported conflicting results, and further research is required to standardize dosing and administration protocols. Intratympanic injections are a promising therapeutic option, and ongoing research is essential to optimize their efficacy and safety.